Presumably this will work?

Wales has become the first part of the UK to adopt an opt-out presumed consent system for organ donation. Presumably, they have considered how this will work in actuality, given that Wales is part of a larger nation, although there is no certainty that they have, given that these are politicians we’re talking about, and they seldom consider the implications of their decisions. Certainly, no further comment has been made on this side of the Anglo-Welsh border about how it will impact on those crossing the border in either direction. Will English holidaymakers have their organs stolen if they are unlucky enough to die in Wales? Will Welsh organs have to be shipped back to Wales if their owner passes away elsewhere in the UK? How exactly is the opt-out being administered?

I loathe opt-out systems because they work on the basis of the state presuming to know my wishes. Assuming I am aware that such a presumption exists and I know how to do so, I can opt-out, of course. But, I do not trust the state to respect my wishes, partly because they are a bunch of self-serving, conniving scumbags (you only need to look at the cover-ups endemic to the NHS to see how patients’ needs, let alone desires, play second fiddle to the whims of doctors and administrators), and partly because they are incompetent (the bungled mess that are my medical records give me no confidence in the medical profession and civil service to keep track of my opt-out status).

I also loathe them because they undermine our fundamental rights. The human body is the property of its inhabitant and, at their death, it becomes the property of their heir (usually their next of kin, unless they have specifically willed it, or parts of it, elsewhere). An opt-out system effectively steals ownership of the body for the state, unless you have specifically told them ‘no’. If someone wants to donate their organs, that’s their decision. Likewise, if the heir wants to donate the organs, it is their property to do with as they wish. The state shouldn’t be allowed to swoop in and seize the body at death any more than it can seize your house on the basis that you forgot to leave a note saying you didn’t want it given to the homeless.

The classic argument, of course, is that a lot of people don’t opt-in because a lot of people don’t give much thought to their dying (or, prefer to bury such thoughts as deep as possible in their subconscious). I don’t think that argument holds much water. Most people fail to opt-in because most people aren’t that comfortable with organ transplants. They might well take them when it comes down to that or dying, much as a starving man might resort to cannibalism, but that doesn’t mean it is something they are really keen on. It is not as if people are unaware of organ donation or the shortage of donors. If the vast majority still fail to sign-up, it’s because the vast majority don’t really want to.

Rather than presumed consent, it would be better if the opt-in system was given a higher profile (put a form through everyone’s door once a year, perhaps) so that those who want to, but who are a little lazy can more easily sign-up. It would also make sense to give adults who have agreed to become organ donors priority on transplant lists in order to encourage people to donate that way. What we should have is informed consent, not presumed consent.